Provider Demographics
NPI:1841207255
Name:JONES, ERIC C (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:C
Last Name:JONES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:IN
Mailing Address - Zip Code:46064-1034
Mailing Address - Country:US
Mailing Address - Phone:765-221-9413
Mailing Address - Fax:765-221-9418
Practice Address - Street 1:138 W STATE ST
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:IN
Practice Address - Zip Code:46064-1034
Practice Address - Country:US
Practice Address - Phone:765-221-9413
Practice Address - Fax:765-221-9418
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2012-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01047098A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00184115OtherRR MEDICARE
IN000000350598OtherANTHEM
IN200195120Medicaid
IN221220AMedicare PIN
ING94694Medicare UPIN